Elderly parent in hospital - whats the procedure for returning home

[Infracat]

My elderly disabled DF (79) with alzheimers had a fall a week ago. He is now in hospital. No breaks luckily but had high blood markers for infection so is on antibiotics. The problem is, he is struggling to walk at all, not sure if due to infection or further deterioration of his condition. They are talking about coming home but having a care package. A local falls prevention team said he can get 6 weeks help at home. Does anybody know how all this works? Or can point me to information please.

Depending on the level of dementia your DF has this may well be a care package provided by the local council, often called a 'reablement' package, if his level of need is higher then it may be an nhs funded package rather than council & would be more a care package pre him being ready for independence, the name of this varies from area to area, but will be along the lines of 'urgent care', both teams tend to work with clients for around 3-6 week, depending on area & need.

You can start with urgent care & then be referred on to reablement.

The level of care will be dependent on how your DF has been assessed in hosptial, some clients will get just a morning visit per day, if they just need a bit of help getting back into routine, others may need more, typically up to four times a day.

Carers will help with personal care, washing, dressing, meal prep and gradually try & encourage your DF to manage tasks on his own again.

The team deciding his discharge will also look at whether he needs help with things like housework/shopping etc... but this would normally be sourced from private agencies or charities like age concern so his funds may need to be assessed.

If he isn't independent after the initial support offered, some teams can extend & they won't just leave him without care, they will work with him & you as his family to assess his needs for ongoing support & help you find a private agency if needed.

Hope that makes sense & it does vary from area to area, all councils have an obligation to have some kind of service but it doesn't look the same across the country

Great answer from PP above. This may also help
https://www.ageuk.org.uk/information-advice/health-wellbeing/health-services/leaving-hospital/

Six weeks is the maximum funded for a discharge package. It is likely to be carers/nursing visits and ot assessment for mobility equipment, bed etc. Any ongoing requirements after that are part of ss assessment and only funded if he falls below the threshold, otherwise self funded. You may at that point have to find a private carers agency to take over.

@Infracat I’m sorry to be negative but have the following cautions:

1. Decide what you are willing to do and try to put this in writing to the hospital discharge coordinator (hospital social worker incorrectly wrote in care plan that family would do ALL domestic tasks and the carer visits only needed to be 2 x carers for short slots, 3 times a day). Ask to see the care plan - especially if it includes what it is assumed family can do.

2. During the first reablement, put in place due to falls, we were given the message that care would fall off a cliff - no advice about finding private care and we had to educate ourselves about funding.

YY to previous posters.

I care for an elderly person (elderly person I care for = EPICF). My experiences is that hospital staff accept the wildly optimistic assertions of the elderly person and will assume they have capacity even if as a family member you are metaphorically dancing naked in front of the staff with "they don't have capacity for X, Y and Z reasons" tattooed across your capacious bosom.

So do be loud and clear you need to be involved in care planning. Ask to see the care plan and check what it says. E.g EPICF told staff they would do all their own food shopping online.

Only problem was at this point they hadn't managed to do an online shop for over 3 months and I'd had to resort to getting neighbours to go round and look in the fridge to see what food was actually needed. It was all very precarious. We lived with precarious for a couple of years knowingly as my Bro and I (we hold PoA jointly) were balancing EPICF's desire to be at home with the risk of something bad happening (getting lost, setting kitchen/house on fire, falling and lying for an extended period, getting an electric shock because despite their urinary incontinence they had got the carer to put the electric blanket back on their bed :-0)

As always with these things it's incremental. In our case the straw that broke the camel's back was the ceiling falling down.... no-one was (badly) hurt. I'm still not entirely sure where EPICF was when it happened. Regardless they got a HUGE fright and moving them out to a residential environment became much easier.

Oh and make sure they have a falls alarm. My suggestion is get everyone who goes in (especially family) to physically check they have it on and then politely bollock the elderly person if they aren't wearing it.

Thank you all. This is really helpful information. The OTs will be coming to see dad tmrw so I will make sure I talk this all through with them.

Oh yes. The falls alarm pendant. Its truly shocking how many elderly people at risk do not wear one and have various excuses. My friends parent only wore it when they came round!

Without sounding harsh (and I will). How dare they put everyone in their family in this position because when they fall those family members often the daughter will have to spring into action to sort out the consequences of their very selfish decision. I bollocked and bullied my Mum so much she cried and promised she would wear it from then on because she was didnt want to feel so upset!

And she did!

Hospital staff and Social Services are under pressure to get elderly people discharged from hospital, and to spend as little as possible on care/reablement at home. They will assume that family (read, Daughter, Daughter-in-Law etc) will step up and provide most/all care required. You have to be very clear and very repetitive in saying, No, I can't do that. No, I have a full time job. No, I have young children. No, I live 2 hours drive away.
Don't get caught up with providing additional help 'for now' - it will be assumed that that is going to be the way forever.

And another consideration - past the 6-week reablement (or whatever) if DF needed care would he be paying for it himself or would it be council funded? Ie does he have savings?

In my experience, OT's and District Nurses are amazing.
Hospital Social workers were dreadful. Really unpleasant. Perfectly willing to facilitate unsafe discharges.
If your DF has capacity then whatever he says will be accepted+ especially around what he can do for himself/you will do. You need to be really on it and prepared for this I'm afraid. In my experience say you're prepared/able to do very little (even if you can do more) as little is on offer.

I have repeated this story before but its worth repeating I think.

I had a friend who was nearly on her knees looking after her elderly mother. Bullied and guilt tripped into having her whole life taken over by her Mum.

In the end she managed to get POA and found that 5 years previously the hospital when discharging the Mum had said she needed someone at home or very nearby to support her. Her Mum said her daughter would do it all and the hospital didnt check this. In some ways I understand why - they just didnt want to know the real answer!

Only issue was that the Mum NEVER told her daughter she had offered her. She knew she couldnt really do it. In the end sadly her husband left her as he felt everything was about his MIL and he came nowhere.

My elderly relative with Alzheimers was discharged from hospital a month after a very bad fall and hip surgery. The discharge team said she was well enough to be discharged home with a 6 week care package (4 visits per day). We asked for the alternative 6 weeks in a care home, but were told this was considered reablement and that it wasn't suitable for people with dementia because they wouldn't retain the re-learning to become independent aspect.

A district nurse visited the house on Day 2 and said she wasn't well enough to be at home alone between care visits. So she was moved to a care home for 6 weeks funded reablement care after all. Solely due to the District Nurse speaking directly with the hospital discharge team.

Eventually back home with a 4 visit per day care package (funded wholly from her savings until they are down to £23,000). This costs just under £2,000 a month and is administered by the LA for an additional £400 annual fee. We couldn't get the carers direct from an agency because the LA had block-booked the majority of hours in our area. So going back through the LA was the only way we could get sufficient visits/hours.

She's had several more falls and hospital discharges home since then. On hospital discharge day, the patient is usually sent home on hospital transport. Sometimes she's been due home at noon and arrived home at 11.30am. Other times, there's been a long delay with the transport (or with the hospital pharmacy dispensing the medication) and she's not arrived home until 8pm. Once having sat all day in a discharge lounge at the hospital and on the ambulance journey in just a thin nightdress (in winter). Even though we'd taken warm 'going home' clothes in the day before.

Usually she has her their personal belongings bagged up and sent with her. But once came back without shoes (custom orthotic ones, so her only pair) and it took over a week for the hospital to track them down. Another time came back with someone else's personal belongings added to her own.

Hospitals are very overstretched. Often hospital discharge is not a smooth process at all. If they will allow you to transport him, or at least sit with him in hospital until the patient transport arrives, it might be helpful.

Hospitals are a complete shambles in my experience. The nursing for my Mum was very patchy and the nurses seemed in many cases to not care less. The wards were awful.

I was there late one night as Mum had taken a turn for the worse and there was a man with just a pull up trying to get into the ward and into the bed of a women by the entrance. The mens ward was the next bay so easy to do. I was the only person in the ward.

There was a women screaming at me and I literally had to run to find a nurse who seems annoyed that I had disturbed her putting some notes on the system

DF has been in hospital twice in the last two years. Had a reablement package on discharge both times: 2 x carers twice a day for personal care and help prep meals if needed (he already had a cleaner and gardener). But it only lasts for about 6 weeks. Luckily he was very clear to hospital and social services that his daughters would not be available to help.

Lots of good advice already but some things I’ve learnt:

• the reablement care package didn’t kick in until the morning after he was discharged. A district nurse did come to check he could get to bed on the evening he was discharged but you might need someone at home for that first evening.
• think about how the carers will get in - we had to put a key safe by the front door. You can also let fire and ambulance service know the code so they can get in in an emergency.
• look ahead and start thinking about care before the reablement package ends. Ask social services for an assessment for long term care needs. (They will want to end the reablement care package as soon as they can.) If it’s going to be self funded then you may find it easier to sort care yourself, although in our case social services did the assessment to understand care needs.

We found there was little physiotherapy support once home. A physiotherapist visited once, said she would send a sheet of exercises but they never arrived. Neither the hospital, the GP or local district nurse team could find out who they were!

We had to have a lot of equipment delivered/ installed before discharge home. This was all free and arranged either by the hospital discharge team or the OT. Included hospital style single bed (raises up and down) and inflatable pressure mattress, inflatable pressure cushion for chair, raised toilet seat on legs, zimmer frame. We also bought privately a pvc fabric armchair with high back and rigid armrests (similar to those in GP waiting rooms) and a small trolley table on wheels that can slide over the bed/armchair for meals. You might also be able to get these free or at very low cost from the Red Cross.

We did try a falls pendant but they're not great for dementia as she would press the button repeatedly when fiddling with it. Many false alarms! Then when she did fall, she didn't think to press the button. They should trigger automatically after a fall but didn't seem to if the fall was gradual, say slipping out of bed. We ended up with bed/chair sensors through the LA telecare team.

Another good backup is a Tapo camera (just one of many brand names) in every room except the bathroom. They can be bought fairly cheaply on Amazon and are a huge help in checking whether a fall is genuine or a false alarm. If your father is worried about privacy, you can place them under a bed or other low furniture. Then you get a full view of the floor as the camera rotates, but can't see higher than about knee-level. It's a good compromise as you can see whether anyone has fallen, and even talk to them on the camera microphone for reassurance, but they still retain most of their privacy.

Going to be very negative, you will have to be on top of absolutely everything, asking questions and chasing people up all the time. Do not take anything for granted, follow up and check everything, if someone cannot answer a question then ask to speak to their senior. Ask for dates when something is going to happen. You can be perfectly polite, but you need to be very very firm.

As an echo a PP IME the community team were good, the hospital discharge team utterly hopeless. Nothing happened unless we chased it up. We ended up having to self-fund continuing care at home for MIL, but there was still a shortage of careers and we couldn't always get the care we needed at weekends.

Good luck OP, you are going to need it.

My DF had a stroke last summer, was 91 years old at the time. He lives alone and I help with shopping, admin, appointments etc but do not have capacity to do more. There is no other family. He was discharged with no help and then the same evening of discharge he had a mini stroke and was admitted back into hospital again. The next morning they called and said he could come home. There was no care plan in place. I refused to collect him until they had something on place. He stayed in hospital four more days and then a care plan was put in place for one visit a day. The carers came for five days, they then said as he could meet three of the five requirements they would no longer attend. I appreciate that the care workers are just following protocol. My advice, as many have said, is don’t commit to more than you can manage. My DF had a falls alarm and doesn’t wear it. What more can I do, I cannot be there every hour of the day and he won’t pay for help. I love him dearly but it is extremely frustrating and draining.

Get to know the discharge coordinator, if there is one. In my local hospital they are either hard as nails Eastern European women who, if in the right situation, can move mountains for you but in the wrong situation can upset everybody at once; or wet as a dishrag and apt to ignore information for a quiet life. They should be able to explain what the options are to you and are at their desks more than the nurses.